A suicide prevention program for Hopi youth

Sot. Sci. Med. Vol. 25, No. 8, pp. 931-940, 1987 Printed in Great Britain. All rights reserved

0277s9536/87 $3.00 + 0.00 Copyright 0 1987 Pergamon Journals Ltd

A SUICIDE PREVENTION PROGRAM FOR HOPI YOUTH

JERROLD E. LEVY’ and STEPHEN J. KUNITZ~ ‘Department of Anthropology, The University of Arizona, Tucson, AZ 85721 and rDepartment of

Preventive, Family and Rehabilitation Medicine, Box 644, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, U.S.A.

Abstract--In recent years, Hopi Indians have been concerned about what they believe are rising suicide rates especially among teenagers and young adults. A review of 30 years of Hopi suicides reveals that: (a) although it is possible that rates are rising, it is more likely that they are relatively stable; (b) high age specific rates for those between 15 and 34 years of age is not a recent phenomenon; (c) the individuals at risk for suicide and for alcohol abuse are the children of parents who made traditionally disapproved marriages, i.e. intertribal, intermesa, and between clans of disparate social status. By labeling the parents as deviant the community creates ‘primary’ deviance in the second generation. To be successful, a suicide program must not be designed specifically for troubled adolescents. Nor can it identify the problem as caused by either acculturation or traditional culture. The proposed program and constraints placed upon its implementation are discussed.

Key words-mental health, American Indians, suicide

INTRODUCTION

The Pueblo Indians of Arizona and New Mexico and especially the Hopi and Zuni tribes have presented themselves to the outside world as peaceful, sober, and cooperative people. The Hopis have been described as gentle, cooperative, modest and tranquil, and all forms of violence, including suicide, are said to be remarkably rare among them [l]. The Hopis’ aversion to drunkenness and their resistance to the incursions of alcohol were noted by observers during the early years of the reservation and in the 1940s [2]. In recent years, however, the majority of Hopis have become concerned about what they believe to be a steady increase of alcohol abuse and suicide.

Public drinking began attracting attention during the 1960s when a number of arrests for drunk and disorderly conduct were made at the Hopi rodeo. During the 1970s drinking in the villages became obvious to almost everyone. Bootleggers sold their wares in the villages, parties were held in private homes, and people complained that teenagers were drinking and using drugs. The Hopi Tribal Health Department had operated an alcohol treatment program since the 1960s which, many claimed, had not had much success. In the late 1970s plans were made for a drug and alcohol education program in the schools. Then, between 1977 and 1979, there were 10 suicides most of whom were between the ages of 15 and 24, and, in 1983, a paper published in the Journal of the American Medical Association reported an annual suicide rate of 118 per 100,000 population in that age group based upon a two year reporting period [3]. In addition to the Hopi ‘alcohol problem’ there was now a ‘suicide problem’ of considerable proportions. Moreover, the community and the health professionals working for the tribe and the Indian Health Service (USPHS) were of the opinion that alcohol abuse was the proximate cause of suicide, car accidents, assaults, and a variety of

misdemeanors and minor felonies. Annual community mental health meetings were inaugurated which discussed the supposed causes and possible cures for this seemingly sudden deterioration of Hopi youth.

It was in this atmosphere of community concern that we reviewed the data on suicide and alcoholism we had been collecting since the mid 1960s and tried our hands at designing a suicide prevention program. The first task was to determine whether community perceptions of the prevalence and causes of suicide were correct and, second, to design a prevention program that took Hopi social as well as epidemiological reality into account. In respect of the former, Shore has noted that high suicide rates among Indian tribes with relatively small populations have received widespread publicity and have been generalized to include all American Indians at the same time that lower suicide rates among larger tribes have received little or no emphasis [4]. In respect of the latter, incomplete and misinterpreted statistics foster misconceptions about the true nature of suicide among Indians and tend to create a negative self image among Indians already facing difficult social and economic futures. Loss of self esteem and mis- taken notions about the extent and nature of the problems make it less likely that suicide prevention programs will be successful.

EPIDEMIOLOGY

The 12 Hopi villages are located on three projections of the southern portion of Black Mesa in northeastern Arizona, which are commonly referred to as mesas. In 1960 about 3800 out of a total of 4700 Hopis resided on the reservation. By 1985 the reservation population had grown to approx. 7600 [5].

Descent is reckoned matrilineally, each individual belonging to one of approx. 50 matrilineal clans.

931

932 JERROLD E. LEVY and STEPHEN J. KUNITZ

Politically the tribe is divided into two factions, one supporting government by the tribal council, the other claiming to recognize only the authority of the traditional theocracy. After the reservation was established, several new villages were settled on land below the mesas that was not clan owned. These villages are usually called ‘progressive’ because (a) they were initially occupied by families who had wage work and who needed easier access to their jobs than was possible living on the mesa tops; (b) they are unable to maintain a complete ceremonial cycle; (c) they tend to support the tribal council form of government. Hopi families have also settled in three off-reservation towns to the south. The ‘traditional’ villages are, in the main, those that were in existence prior to white contact, maintain a complete ceremonial cycle, and whose religious leaders oppose the tribal council.

Suicides, suicide attempts, homicide, alcoholic cirrhosis, and various diagnoses indicating the presence of alcoholism were documented for the years 19561965. Information on age, sex, method, residence, natal village, clan affiliation, and father’s clan was recorded. Hospital records for the hospitals serving Hopi patients [6], Hopi tribal police records, newspaper accounts and death certificates were reviewed. Subsequently, suicides occurring between 1966 and 1985 were obtained from the suicide register kept by the Field Health Department of the Hopi Service Unit (IHS) in Keams Canyon. Clan affiliation was not recorded in this register. Forty cases of suicide were documented for the 30 year period. Place of residence was not verified for ten cases obtained from the Hopi tribal police during the years between 1969 and 1977. In consequence, rates for those years have been calculated as a range, from a low based only on cases with known reservation residence to a high which includes all cases of unknown residence. Because the high rates include the suicides from the border towns, they are overestimates.

Prevalence

Suicide rates, even when stable, are always either rising or falling. In larger populations the percent increase or decrease each year is usually minimal. For the 30 years between 1950 and 1980, for example, the national suicide rate has remained remarkably stable: 195CL11.4; 196GlO.6; 1970-11.6; 1980-11.9 [7]. In very small populations, however, rates may fluctuate widely from year to year. For example, Conrad and Kahn reported an average annual suicide rate of 30 among the Papago Indians for the three year period, 1969-1971 [8]. When, however, an average rate is calculated for a five year period, it is only 18 which places this tribe among the lower risk tribes for self destructive behavior [9]. Because the study which reported high suicide rates among Hopis between 15 and 24 years of age was based on a two year reporting period we questioned whether it could be accepted at face value.

Suicide is said to have been very rare among the Hopis prior to 1950 although, in a population that numbered only 2200 in 1880 and 3558 in 1943, there would have been no more than two suicides every ten years if the rate were in the neighborhood of 10 per 100,000 population. Indeed, speaking of the 1940s

Table I. Three year running average suicide rate for reservation Hopis and selected Arizona counties*

Year Hopit Yavapai Apache Navajo

1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985

20.0 6.9 16.8 17.4 16.8 20.0 16.1 24.1 7.7 19.5 7.4 20.5

13.5 14.2 20.3 16.9

19.4-38.8 12.6 12.4-37.2 20.4 17.9-53.7 21.6 17.2-40.1 31.8 22.5-50.7 28.0 I l&27.5 28.4 5.4-16.2 23.2 5.3%10.6 29.0

20.8-26.0 27.5 35.740.8 29.4

50.3 26.7 39.7 28.3 33.8 24.5 23.7 22.8 23.2 13.7 13.4 13.1

14.8 13.8 15.6 10.0 6.9 8.8

10.7 10.6 13.6 12.6 22.6 23.5 29.3 25.7 23.9 20.8 23.9 21.5 20.3 14.9 13.4 11.52

10.5 13.7 18.0 15.2 11.7 6.1

12.0 10.4 15.5 15.8 20.3 18.3 17.9 12.4 12.6 13.6 12.6 15.8 21.9 18.4 16.3 13.3

*County populations from: de Gennaro N. (Ed.) Arizona Statistical Abstract: A 1979 Data Handbook, Northland Press, Flagstaff, Ariz. (in cooperation with the Divison of Economic and Business Research, College of Business and Public Adminis- tration, University of Arizona, Tucson), 1979; Arizona De- partment of Economic Security. Arizona Population Estimates. Phoenix, 1983; Arizona Population Projections. Phoenix, 1986. County suicides from: US, DHHS, Public Health Service, Vital Statistics of the United States. Hyattsville, Md, 19661981

tHopi reservation sucides: low rate based on suicides with known reservation residence; high rate includes suicides of unknown residence.

Brandt reports that ‘only’ two cases were recalled from ‘recent times’ [lo].

Table 1 displays suicide rates as three year moving averages for the reservation Hopis and three rural counties in the northern part of the state. Hopi suicide rates are no higher than those of the neigh- boring rural counties and peak in approximately the same years. Yavapai county has a very small Indian population, yet suicide rates are generally higher than those of Navajo and Apache Counties which include large areas of the Navajo reservation and all of the Hopi. Nationally, rural areas tend to have lower suicide rates than urban areas [l 11. This pattern appears to be reversed when the rural Arizona counties are compared with Maricopa County which has the largest urban (Phoenix) population in the state. In 1960 the three year average suicide rate in Maricopa County was 13.4. By 1977 it had risen gradually to 18.4. Table 2 shows that Hopi suicide rates are about the same as, and also move in tandem with, those of the New Mexico Pueblos.

It is not certain that Hopi suicides are on the increase. On the one hand, the counties we have surveyed suggest that the rates throughout the state may be rising. Although there is no statistically significant increase in Honi suicide after 1970. it is qiite possible that the Hopi rates are increasing along with those of other counties with larger populations. On the other hand, the years since 1980 have seen a return to the rates characteristic of the 1960s. Data

A suicide prevention program for Hopi youth 933

Table 2. Average annual suicide rates by overlapping decade for Hopis and New Mexico tribal groups

New Mexico*

Period Hopis Pueblos Navajos Apaches

19561965 8.0 14.2 8.9 22.4 1961-1970 13.0 24.9 5.7 33.0 19661975 14.1-29.9 32.8 9.1 55.36 1971-1980 25.1-34.5 37.3 14.3 47.1

*Source: Van Winkle N. S. Native American suicide in New Mexico: a comparative study (1957-1979), p. 79. Unpublished Master’s dissertation, Dept of Sociology, University of New Mexico, Albuquerque, N. Mex., 1981.

for Arizona counties for the years after 1981 are not yet available so it is not yet possible to say whether their rates are undergoing a similar decline.

The importance of these observations for our purposes is that they caution against seeking after- the-fact interpretations specific to the Hopis and also against using national statistics as a standard for comparison. If a general process of acculturation and social disintegration is the cause of rising suicide rates among Indians, why have the Navajos maintained consistently lower rates and only shown an appre- ciable rise since 1970? Why do the Hopis and New Mexico Pueblos show the same increases and virtually identical rates when the New Mexico Pueblos have a longer history of intense contact with non- Indians, have been more integrated into the wage economy, and have had larger proportions of their populations living off reservation than the Hopis? And, finally, why should Hopi rates covary with and be of the same magnitude as those of the surrounding counties?

Age and sex

Hopis have expressed concern that suicide is increasing among adolescents between 15 and 19 years of age. What must be determined is whether there has been an increase of suicide in this age group or if age specific rates have always been high among younger Hopis. The media have given much attention to the fact that, nationally, suicide rates in the 15 to 25 year age group have risen from 4.5 in 1950 to 12.3 in 1980. Age specific rates for the 15 to 19 year age group have only been reported since 1970 when they were 5.9. By 1980 they had risen to 8.5 [12]. Are Hopi perceptions being influenced by media publicity?

Table 3 displays Hopi age specific suicide rates by five year age groups for the years 1956-1970 and

Table 3. Hopi age specific suicide rates (per 100,000 population): annual average for the years 1956-1970 and 1971-1985

195C-1970 1971-1985

Age Number Rate Number Rate

15-19 1 14.6 7 63.5 20-24 2 44.0 9 123.0 25-29 2 52.7 7 114.3 30-34 1 16.0 4 68.8 35-39 I 19.9 4@44 1 37.5 I 23.2 45-49 I 47.3 50-54 55-59 60+ I 20.6

Age unknown 2 -

Total II 29

1971-1985. There has been virtually no change in the age specific rates. Although it looks as if the rates for those between age 15 and 29 have risen there is no significant difference between the two 15 year periods [15]. It would appear that higher age specific rates in the younger age groups is not an entirely new phenomenon. In fact, the pattern is more like that of the Navajos than that of the nation [14]. Nationally, suicide rates tend to rise with age, reaching their peak in the 75-84 year age group. We think that Hopi perceptions have been shaped-first, by improved reporting and, second, by heightened awareness re- sulting from local and national media coverage. There appears to have been a brief suicide ‘epidemic’ between 1977 and 1979. Of the 10 suicides completed during the three year period, four were between 15 and 19 years of age, and two were aged 20 to 24. These cases were reported in the local Hopi newspaper and much commented upon in community meetings. In earlier years, suicides were not publi- cized and peoples were, in most instances, aware only of events taking place in their own village.

Among the Hopis, men commit suicide 13 times more often than do women. This ratio is the same as that found among the other tribes of the Southwest [15] but considerably higher than the 3: 1 and 7: 1 reported for the general population [16]. The sex ratio has not changed over the past 30 years.

The association of suicide with alcohol abuse

Information on the number of suicides in which alcohol was involved was incomplete. What information was available, however, strongly suggests that the suicidal act is associated with alcohol abuse in several ways. Some suicides were intoxicated at the time of death. A few committed suicide while in jail on a charge that involved drinking. A number of the younger suicides were adolescents who had serious conflicts with their alcoholic fathers, who then took to drink themselves, and subsequently committed suicide. In some families drinking and violence in the parent generation triggered the suicide of sons. One family stood out in this regard. The father began to drink while in his twenties. Social pressure forced the family to leave the village and to move to one of the ‘progressive’ villages. The father became a bootlegger and his wife also took to drink. Finally, the couple settled in one of the border towns where the children completed their educations and gained employment. The family was joined by the man’s brother and his family. After some years, the father murdered his wife who, the autopsy revealed, suffered from alcoholic cirrhosis. Within two years, two sons committed suicide and a daughter and niece began having hys- terical attacks. Some years later, the father died from alcoholic cirrhosis. Several other families had similar if somewhat less dramatic histories. The general pattern is that of drinking leading to social disapproval and ejection from the village and the subsequent problems of the children.

Residence

Although many Hopis have the impression that drinking and suicide are more prevalent in the progressive villages and off reservation border towns this seems not to be the case. Although we found that


no cases of cirrhosis, suicide, or homicide were reported in ‘traditional’ villages between 1956 and 1964, diagnoses of alcoholism and problem drinking replicated the distribution of the control group [17]. In both, approx. 50% resided in ‘progressive’ villages. That alcoholism was found in all villages suggested that drinking and social deviance were being gener- ated in the ‘traditional’ villages at about the same rate as in the ‘progressive’ villages but that the ‘traditional’ villages expelled deviants before alcoholic cirrhosis developed and before the deviant’s career was terminated by suicide or homicide. When the cases were grouped by village of origin, there was no difference between cases of social pathology and the controls. While making a census of Hopis living in the border towns of Holbrook, Winslow and Flagstaff, Arizona, male heads of household invari- ably told us they had left the reservation in search of better job opportunities. Many of the wives, however, confided that they had to leave because of the husband’s drinking.

The distribution of suicides by residence for the 30 year period, 19X-1985, was identical to that of the earlier control group and the cases of alcoholism. Nor had the proportions changed over time there being no difference between those suicides committed between 1956 and 1970 and those occurring between 1971 and 1985. The absence of suicides in traditional villages between 1956 and 1965, although perhaps an earlier pattern, is quite as likely to have been due to chance.

Deviant families

The individuals at risk for social deviance in the 1956-1965 study were the children of parents who had made ‘deviant’ marriages. Traditional Hopi society, in contrast to those of most other Indian tribes, was tightly structured, demanding the submission of the individual’s will to that of the community. Com- petition between individuals or kin groups was disvalued and highly disruptive. Internal cohesion was enhanced by village or mesa endogamy and, within the village, by the tendency to marry a person of comparable economic and, in consequence, ceremonial rank. Any breach of these rules of endogamy fostered conflicts of loyalty and competition between families of different statuses.

In 1916, Lowie found that between 87 and 90% of marriages on First and Second Mesas were of individuals from villages on the same mesa [18]. The same proportions were found among the marriages of the parents of the cases of deviance documented between 1956 and 1965. The cases living in the ‘traditional’ villages continued to make endomagous marriages (85%) but those from the ‘progressive’ villages showed a marked tendency to make exogamous marriages (49%).

The man who married and went to live with a woman from another mesa could not fulfil his ceremonial obligations to his matrilineage; nor did he have kinship or ceremonial affiliations in his wife’s village. Because land was inherited matrilineally, the woman who went to live in her husband’s village forfeited her interest in farm lands controlled by her matrilineage in order to live with a man who could not inherit productive land in his own village. Mar-

riage to a woman from another village on the same mesa, while not desirable, did not hinder the per- formance of ceremonial or kinship obligations to the same extent as the intermesa marriage. Except for marriages between the Hopis and Tewas of First Mesa, marriages to persons of another village on the same mesa were not counted as exogamous and disapproved.

In the endogamous marriage, both sets of relatives had some interest in helping the young couple adjust to married life. The family of the man who had made an intermesa marriage, on the other hand, might even desire his return home while that of the bride could blame their son-in-law for any marital disagreements and might even create a climate conductive to marital discord. The children of such marriages would, in consequence, be reared in a stressful atmosphere and would be in a socially anomalous position due to the fact that the family of one of the parents would be unable to fulfil their many obligations to the children.

Although, in principle, marriages between Hopis and the Tewas of Hano village on First Mesa were permitted, they were not approved in practice. Writ- ing in the 1890s Stephen noted that a Tewa youth recently married to a Hopi woman of Walpi, dreaded meeting his Hopi age mates [19]. Dozier commented on the antagonisms between the two groups and the legend which purported to explain the inability of the Tewas to assimilate despite considerable intermarriage [20]. Both authors noted the frequency of intermarriage. Table 4 shows that, on First Mesa, social pathologies were found among the offspring of Hopi-Tewa and intertribal marriages significantly more often (46%) than among the controls (16%).

Because First Mesa is the only one that includes an intrusive population, albeit one that has been a part of Hopi society for some two centuries, it is important that the association of social deviance with exogamous marriages is also found on Second and Third Mesas. But intermesa marriage in the parent generation was almost as rare as intertribal marriage in those villages. None of the cases of social pathology on Second Mesa and none of the controls on either mesa were the issue of exogamous marriages. Only on Third Mesa was there an indication that exogamous marriage put the children at risk for social pathoIogy. Eight (Hi%) of 50 cases of socia1 pathology were the children of exogamous marriages, a distribution which is not significantly although alI of the exogamous marriages predicted social pathology in the next generation.

The need to avoid conflict, however, was also reflected in a tendency to marry within the same social stratum [21]. Because Hopi society is most often described as egalitarian, some explication of

Table 4. Marriages of parents of First Mesa cases of controls and all social pathologies, 19561965

Marriage

Hopi/Hopi Tewa/Tewa Hopi/Tewa Other tribe Total

Controls 38 7 0 45 Social pathologies 25 16 5 46

63 23 3 91

Chi square = 11.3; df = 2; P < 0.01.


Hopi social stratification as in order. Prior to the decline of agriculture, which began after the droughts of the late 19th century, the best farm land and all religious ceremonials were owned by those clans who, according to myth at least, were the first to arrive in Hopi land. “The last arrivals often possessed no rituals and offered their services as guards. Their position was marginal and usually they were not assigned clan lands” [22]. Within the village, the clan was divided into lineages. A ‘prime’ lineage occupied the clan house, looked after ceremonial property, and administered clan owned farm land. An ‘alternate’ lineage stood ready to inherit leadership positions should the ‘prime’ lineage lack heirs. The most marginal lineages were expendable in times of crisis. There were, in consequence, high and low status clans and, within each clan, high and low status lineages.

But while intertribal and intermesa marriages were always disfavored, interstatus marriages were often deemed desirable. During periods of economic expansion-wet years increased agricultural pro- duction-families of high status sought to increase their manpower by marrying their daughters to ener- getic, lower status males. Later, during periods of economic contraction, these individuals and their families sought to maintain their reflected status by laying claim to prestigious ceremonial positions they often held on behalf of their wives’ families in the event these did not have eligible males available at the time the position became vacant. In sum, predictable lines of internal dissention and conflict appeared during hard times.

These structurally anomalous families were, and still are, subject to considerble community engen- dered stress. One of the parents and all of the children were treated as deviants and suffered thereby. The marriage of low status women to high status men brought no benefits to the grooms’ families and was opposed by them. Brandt tells of one such marriage that ended badly. Informants recognized that ambi- tious individuals would seek to improve their position by marrying above their status, that mixed status marriages placed strains on the lower status spouse, and that high status families preferred to marry among themselves.

The marriages of the parents of virtually all the individuals in the study of social pathology took place between about 1880 and 1930. Assuming that the status of the parents’ clans was that which prevailed from the turn of the century to about 1930, clans were assigned one of two ranks based on information provided by Eggan [23] and Titiev [24]. High status rank was assigned only to those clans that owned religious ceremonies. All other clans were ranked as low status. The social reality is more adequately represented by a three rank classification but sufficient information for this task is only available for the village of Old Orabi. High rank, by this classification, was assigned only to those clans that owned major ceremonies. The middle rank included those clans that (a) owned a lesser ceremonies or (b) provided various ceremonial officers or the War and Crier chiefs but owned no ceremonies.

Using the two rank system, children of mixed status marriages were at risk for social pathology significantly more than were children whose parents

Table 5. Parents’ marriages of cases of controls and all social pathologies with mothers from the traditional villages of Second and

Third Mesa, 19561965’

Marriage

Same rank Mixed rank Total

Controls 16 2 18 Social pathologies 8 9 17

G IT 45

Chi square corrected for continuity = 6.2; df = I; P = 0.02. *Only intramesa marriages with clans of both parents known are

included. Marriages of Shipaulovi mothers excluded as clans of that village could not lx ranked satisfactorily.

married into clans of the same status (Table 5). It was the breach of a clan status endogamy rule that, although not as explicitly stated as those prohibiting intertribal and intermesa marriages, predicted social pathology in the ‘traditional’ villages where social controls were sufficient to inhibit intermesa marriage almost completely. There were only seven intramesa marriages in Old Oraibi, too few for anlaysis. None of the four controls were children of interstatus marriage. Of the three cases of social pathology, two were the children of marriages between individuals of the highest and lowest ranks. This suggests that marriages which unite clans of very different statuses are those which create the greatest stress.

On First Mesa 46% of the alcoholics, suicides and homicides were children of deviant marriages. In the traditional villages of Second and Third Mesa 53% were children of mixed rank marriages. Although we do not have the clan affiliations of the suicides’ parents after 1965 we believe that the suicides also follow this pattern. Not only is the association with alcoholism strong but the age groups that commit suicide the most have remained the same over time. Thus, the risk factors for suicide and social deviance generally, we believe, derived from stresses within traditional Hopi society, a society that has changed considerably over the past century. How is it possible for the patterns of the past to persit in the present; and how can we be sure that other areas of change are not contributing to the number of suicides?

Change

Traditional Hopi society maintained stability and integration through the promotion of homogeneity both structural and psychological. Survival depended on unending fieldwork and intense cooperation. To achieve this, the ideology had to be egalitarian while all manifestations of individualism-competition, in- novation, ambition-were severely discountenanced. The economic realities, however, did not permit social equality. The agricultural resources were local- ized and marginal and, during periods of drought, the land could not support everyone. A core population had to maintain itself in s&h a manner that excess population could be sloughed off without creating serious internal conflict. This was achieved by a hierarchical system which concentrated control of resources and ceremonial positions in the hands of a relatively small proportion of families. Roughly 60% of marriages of parents of controls were of lower status clansmen only. In Old Oraibi, 43% of the clans were of the lowest status while 30% occupied the second rank.


Only the endogamous marriage, which balanced ceremonial status and wealth could maintain un- divided loyalties. Not only was the egalitarian ideology at variance with social reality but the specialized, unilateral social structure, otherwise an efficient mechanism for providing continuity in the trans- mission of property and position, was under considerable strain when faced with changes of any magnitude. Such changes commenced during the latter half of the 19th century and have continued since that time.

Severe drought from 1864 to 1866 and two small- pox epidemics, in 1853 and 1866, decreased the population by about 20% and precipitated westward migrations, initially from First to Second Mesa and, after 1867, from Second to Third Mesa [25]. These dislocations and hardships placed the least secure segments of the tribe in very difficult circumstances. After the establishment of the reservation, in 1882, agriculture continued its decline due to a cycle of dessication which began around 1880.

Improved transportation, education and possi- bilities for employment not only increased opportunities for deviant marriages but also for individual entrepeneurship. Increasingly, people were forced to devote more effort to stock raising and, later, wage work, both activities accruing wealth to individuals rather than to lineages. The ‘traditional’ village of Hotevilla, settled by Third Mesa people opposed to government policies in 1906, was never able to create a system of clan ownership of land. Several informants aver that many low status clansmen moved to the newly established village of New Oraibi just so they could farm individually owned fields.

By the start of the Great Depression, the system of land tenure had been modified considerably due to the emigration of individuals to off-reservation border- towns, to the government Agencies in Tuba City and Keams Canyon, and to the new ‘progressive’ villages [26]. In 1936, agriculture accounted for 44% of Hopi income [27]. By 1942, only 22% was derived from agriculture while wage work accounted for 36% and stock raising and private business another 38% [28]. By 1952, wage work provided 75% of all income [21].

During these years, clan status came to depend entirely on the ownership of ceremonies and, since the Second World War, the expanding wage economy has seriously eroded the ceremonial system. Young men can no longer afford the time or the loss of mobility required if they are to assume priestly roles. The Snake and Antelope societies no longer function on First Mesa. Traditional leadership has been mori- bund in two of the Third Mesa ‘traditional’ villages for some years. There is, presently, no village chief in the largest ‘traditional’ village of Third Mesa and there is some speculation that the Snake and Ante- lope societies will soon die out there as well. In order to escape village constraints, younger couples have been building homes outside the ‘traditional’ villages. Whatever adjustments may be made in the future to ensure the survival of religious life, they will not include a system of clan ownership of ceremonies.

In sum, the economic and religious reasons for maintaining endogamous marriage have disappeared. That disapproval of exogamic marriage persists is due to a disjunction of older norms and new econ-

omic demands. With the passing of the present senior generation, acceptance of intermesa and of what, until now, has been mixed status marriage will, most likely, become the rule. Moreover, the increased incidence of such marriages should not generate new social pathology.

The association of suicide with excessive drinking and the prevalent belief that alcohol consumption is on the rise has been taken by health providers on the reservation as the reason for the supposed increase of suicide and an indication that the rates will continue to rise. Yet, despite real changes in drinking styles, there is little hard evidence to suggest that alcohol consumption is also increasing.

There was an “almost total absence of liquor on the reservation” in the 1930s and 40s [29] and even during the 1960s public drinking was rarely seen in the villages. Yet for the three year period, 1965-1967, there was an average annual gross mortality rate from alcoholic cirrhosis of 43.3 per 100,000 population as compared with the national rate of 12.1 for all cirrhosis deaths [30]. While these rates, based on such a short reporting period, probably represent a peak of brief duration, they do indicate that considerable amounts of alcohol were being consumed prior to the observed increase of drinking in public.

Alcoholic cirrhosis is a relatively direct gauge of high alcohol intake. The form of excessive drinking which results in cirrhosis is the steady consumption we generally associate with the chronic alcoholic or addictive drinker in our own society. Mortality or incidence rates of cirrhosis would not accurately reflect sporadic binge drinking, for instance. Nor would they indicate the total number of other types of drinkers in a population.

Strong disapproval of drinking forced Hopi men to drink covertly. Supplies of alcohol were hidden near the fields and drinking took place at some distance from the village. When one old man died from this disease, his wife and grown children were shocked. They had been totally unaware of his drinking. Cirrhosis deaths during the 1960s reflect the drinking of the 1940s and 1950s and it is certain that the above mentioned patient had been drinking for some years before he died.

Many Hopis believe that problem drinking only began after the Second World War. Men were said to have learned to drink while serving in the armed forces. Yet none of the alcoholics we interviewed dated the onset of their drinking to the war years. According to their own accounts they started drinking on the reservation prior to any military service. They did, however, say that while in the service, they were able to drink openly with friends and that they rebelled against the need to drink secretively at home. Veterans of the Korean war began to drink openly in protest against the lack of recognition given them by the older generation of veterans and what they per- ceived to be the hypocrisy of their elders who preached to them against drinking:

Access to alcohol was also becoming easier as new roads were built and Indians were allowed to purchase liquor in off-reservation areas after 1950. We have already noted that public drinking began attracting attention during the 1960s and that drinking in the villages became obvious to almost everyone


during the 1970s. Nevertheless, the average annual mortality rate from cirrhosis between 1971 and 1977 was 37.3, virtually unchanged from the 1960s [31]. Whether the drinking of the 1970s will result in higher mortality rates during the decade of the 1980s re- mains to be seen. Thus, despite the considerable changes undergone during that past century, the interpretation of the epidemiological data must be undertaken with great caution. Although older patterns may die out in coming years at present it is safer to conclude that suicide rates are probably not rising and that suicides occur largely in families labeled as deviant by the society in accordance with norms of the past.

COMMUNITY A’ITITUDES

From our analysis of the epidemiological data we have concluded that community attitudes themselves create deviance. Regardless of the reasons the parents of our cases may have had for making disapproved marriages in the first place, their children were labeled as ‘deviant’ from birth, a circumstance which caused them to behave in the manner expected of them by the community. Students of social deviance have pointed out that communities need to define those areas of experience which threaten their security; that the deviant who has gone beyond the permissible serves as an example of what ‘evil’ looks like and thus functions to promote a sense of community identity and cohesion. In Kai Erikson’s words, “ deviance cannot be dismissed simply as behavior which disrupts stability in society, but may itself be, in controlled quantities, an important condition for preserving stability . . ” [32].

In past years, the few deviant families in each Hopi village served not only as examples of the consequences of improper behavior but also as scape- goats, convenient targets for the release of pent up hostility. In one traditional village, for example, a woman and her grown daughter were known as heavy drinkers. Their slovenly appearance and their run down home were publicly ridicled while the children were teased by children as well as adults. Through the efforts of Hopi alcoholism counselors, the two women were able to remain sober for several months and to improve their personal appearance and living conditions appreciably. The villagers, in- stead of being pleased, increased their abuse, making such statements as “who do they think they are to dress so nicely? They are nothing but drunkards.” The villagers resented the loss of their whipping boys and, before long, the women returned to their drinking.

Even the anticipation of community disapproval may have disastrous consequences. One young man who wished to marry a girl from another tribe committed suicide after the family repeatedly refused to countenance the marriage. The shame of deviance in the family and the knowledge of how the community will react lead family members to deny its existence whenever possible. An extreme example is provided by the case of a man who, after attempting suicide twice by drug overdose, finally achieved success by inserting the muzzle of a rifle in his mouth and triggering it with his big toe. After each attempt, the

family announced that attending physicians told them the drug ingestion was accidental. After the suicide, the wife insisted that the rifle discharged because her husband had used bullets of the wrong caliber.

But if families of deviants fear social ostracism, the community itself is often reluctant to move against them and, to all appearances, accepts the families’ explanations. Several examples from the 1920s and 30s are provided by the Beagleholes [33]. In one case, an elderly widower raped a five year old girl for which he was sent to jail. After his return, however, his status in the community was apparentfly no different from that of any other old man. In a case of mother-son incest, the family brought no charges against the son who continued to live in the village. The family claimed that the mother, who was about 60 years old at the time, was nearly blind and too obese to know what her son was doing to her. That charges in tribal court may not be made and offenders not ejected from the village does not mean there are no untoward consequences, however. Subsequent misfortunes in the immediate family are attributed to the original deviant act so that considerable time may pass before family stability is restored.

The labeling hypothesis holds that everyone devi- ates from some standards of the society at some time but that only those officially labeled as deviants are stigmatized and, subsequently, unable to act in any way different from the role ascribed to them [34]. Although many deviant acts are disruptive so also is social ostracism. In little communities like those of the Hopi villages, official response to more than a few instances of deviance would, of itself, destroy social cohesion and threaten survival. A seemingly high level of tolerance toward deviant acts may, in consequence, be displayed by the community at the same time the acts may be strongly disapproved. In our opinion, acts such as exogamous marriages which create persisting structural tensions are the ones which must, ultimately, elicit community reaction.

Hopis of all ages believe that social pathology beean its increase after contact with the whites. But. whereas the older generation believes that the presen; state of affairs is due to increased immorality and, thus, a fall from a superior moral state, many younger Hopis are coming to accept the dominant society’s view of these behaviors as symptoms of personal and societal ‘illness’ and are beginning to think of themselves as a sick society. Accepting the explanation that social deviance is the direct consequence of social disintegration permits the community to view deviance as a response to new social conditions. And, because these conditions have been imposed by the dominant Anglo society, no blame attaches to the values of the parental generation. Indeed, many Anglos have encouraged the Hopis to view the modern Anglo world as the cause of all their ills.

Community mental health meetings, held during the past few years, have devoted much energy to presenting traditional values and lifestyles as the antidote to contemporary mental health problems. From this premise it follows that, if alcoholism is defined as a disease introduced by the Anglos, it is their responsibility to provide cures and to undo the


damage already done. But when a community per- ceives of itself as ‘sick’ and looks to the very source of its problems for a cure, it has abrogated responsibility for its own actions and done considerable damage to its self image. Moreover, to the extent a return to an idealized Golden Age is seen as a solution, innovative and adaptive strategies are precluded.

Elsewhere we have argued that the federal government has most often discharged its obligations to Indian tribes by spending money on expanded health and human services rather then improving reservation economic condition [35]. The continued employment of the growing number of younger Indians in the health delivery system comes to depend on a continued need for these services. And, as infectious diseases come under control, attention turns increasingly to such conditions as alcoholism, mental health and accidents. Budget justifications are based on arguments for the high prevalence of such problems in Indian communities. There are, in consequence, some very powerful economic reasons for Indian communities to accept the image of the ‘sick’ Indian offered them by the dominant society.

An essential task for prevention programs is the identification of community strengths rather than deficits or weaknesses [36]. The self image of an ethnic minority is often poor and, what strengths it has, are always threatened. Avoiding further erosion of the positive aspects of the Hopi community’s self image poses problems which a prevention program cannot afford to ignore.

PREREQUISITES FOR SUCCESSFUL PREVENTION

The epidemiological research has confirmed community concerns about suicide among adolescents and young adults generally. Thus the prevention program should be designed to work with children and adolescents in the seventh and eighth grades as well as with the high school age population. The research also identified risk factors which could not be predicted by clinical experience or a general famil- iarity with Hopi culture and daily life. But because these factors did not predict more than about 50% of all cases of sociopathology and seem likely to change in the future, epidemiological research should be ongoing and an integral part of the program’s evalu- ation component. For these reasons also it is important that the program should attract individuals currently not thought to be at risk so that new patterns can be identified as early as possible. It should also be noted that, as the same risk factors predict a variety of social pathologies, program eval- uation should be designed to measure a variety of problems not just suicide and suicide attempts.

Most suicide prevention programs are designed to intervene after an individual has made a suicide attempt or gesture or has otherwise identified himself by using a ‘hot line’ to talk about suicidal impulses. Some programs also pay special attention to de- pressed adolescents. In small rural communities early intervention may unintentionally make public the deviant status of the participant. The health professionals who design prevention programs in the areas of mental health and social deviance tend to define

the problem as a medical one [37]. The potential suicide is viewed as a patient with a sickness that can be treated. According to this view, there is no moral component and, in consequence, no reason for individuals in need of treatment to avoid it. When, as is so often the case, the community does not share the professionals’ definition of social deviance, the response is often to ‘educate’ the community by increasing pulbic awareness.

We have seen that the labeling process plays a major role in creating primary deviance among the Hopi, that the individuals most at risk for suicide have already been labeled as deviants by the community by virtue of their parents’ transgression of the moral code. This makes it imperative, in our opinion, that the program should not be identified as a suicide .prevention program and that it should not be a part of either the tribal or federal health delivery system. To be so identified would keep individuals not already thought to be deviant from participating at the same time exposing those who do participate to community censure even before any deviant act is committed. Hopi tribal alcohol treatment programs have found it virtually impossible to get drinkers in the ‘traditional’ villages to participate for this reason and it seems certain that youths most in the need of help would feel vulnerable if it were known that they voluntarily participated in a ‘suicide’ program.

Another problem, leading to the same recommen- dation, derives from the fact that social deviance reflects stresses in the traditional society. A program explicitly designed to prevent suicide would, in the process of eliciting community support, be con- strained to provide the community with information about suicide and its causes. To the extent that patterns of Hopi suicide are discussed, many in the community will feel that the values of traditional Hopi society are being impugned. Conversely, to continue portraying suicide solely as a consequence of acculturation and social disintegration runs the risk of supporting a back to the past attitude on the part of the older generation and further supporting the image of the ‘sick’ Indian among younger, more educated Hopis. The former approach, we have already noted, discourages the search for adaptive innovations while the latter abrogates community responsibility for making decisions about the future. The best course, in our opinion, is to avoid the issue entirely. The announced goal must be the enrichment of the life of adolescent youth generally. Such a goal is consonant with the concerns of Hopis and Whites alike and would not single out the Hopis as having a special problem apart from the rest of society.

Currently, the Indian Health Service (USPHS) provides patient oriented treatment services to the reservation while the Hopi Tribe administers a variety of community oriented activities among which are the alcohol treatment program and a program for juvenile delinquents. During the past few years the tribe has sought funding for its own hospital. The kind of program envisioned here cannot be part of direct treatment programs if it is to avoid the label of being specifically for deviants but would fit better with the Tribal efforts in the area of education regardless of the ultimate source of funding.

Finally, in the present climate of fiscal restraint, the


cost of the program must be minimal if it is to have any chance of receiving support. There ought to be no space requirements beyond those for meeting rooms or recreation areas which should be available in already existing tribal facilities. Equally important is the need to keep permanent professional staff to a minimum and to rely as much as possible on volun- teer help from the community.

Wilderness adventure programs may well fulfill these requirements. They have enjoyed some popu- larity both as programs designed specifically for delinquent youth (Vision Quest) and for general enrichment and confidence building among freshman college students (Outward Bound). While relying on their general appeal, they may incorporate prevention components such as education and counseling without seeming to do more than address the needs of adolescents generally.

A professional staff of two-the group leader and a skilled counselor-with the assistance of some local aides would be adequate to run a program for all of the villages which have a population of about 1500 youngsters between the ages of 10 and 19 years. This assumes that participation will be less than loo%, especially during the first few years. Staff can be added after initial success has been demonstrated. Participation would be voluntary and the population at risk would not be subject to special recruitment efforts.

The effect of such an arrangement would be to create a ‘treated’ and ‘untreated’ group in each village, each comprised of individuals thought to be at risk as well as those not at risk. Data could be collected on the entire age cohort year by year. Baseline data for a variety of social problems could be used to measure success as well as to identify newly emergent patterns. In addition, stigmatization of individuals at risk would be minimized and troubled youngsters would benefit from interaction with well adjusted youths with leadership skills.

The advantage of such programs is their broad appeal and their low cost. In pressing for their adoption, however, it is well to proceed cautiously. Presently, the Hopis and several other tribes are funding treatment programs for juvenile delinquents and alcoholics. A prevention effort which is not billed as a salient contribution of the health establishment may have difficulties getting bureaucratic support during a period of fiscal restraint when existing programs and the academic consultants who serve them are fighting for their own survival.

REFERENCES

Thompson L. and Joseph A. The Hopi Way. U.S. Indian Service, Lawrence, Kans., 1944. Donaldson T. Moqui Pueblo Indians of Arizona and Pueblo Indians of New Mexico: Extra Census Bulletin, 11th Census of the United States, pp. 19 and 26. Government Printing Office. Washineton. DC.. 1893: Crane L. Indians of the Enchanged Deiert.‘p. 297: Little Brown, Boston, Mass., 1925; Thompson L. and Joseph A. The Hopi Way, p. 47. U.S. Indian Service, Lawrence, Kans, 1944. Simpson S. G., Reid R., Baker S. P. and Teret S. Injuries among the Hopi Indians. A population based survey. J. Am. med. Ass. 249, 1873-1876, 1983.

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Shore J. H. American Indian suicide-fact and fancy. Psychiatry 38, 8691, 1975. For various reasons the Hopi population has been difficult to enumerate. Language barriers, outmigration, shifting residence, and inadequate recording of births and deaths until about 1955 have all contributed to the problem. Bureau of Indian Affairs estimates show increases from a total of 2200, in 1880 to one of 3558, in 1943. From 1933 to 1943 there was an annual increase of about 2.1%. (Thompson L. Culture in Crisis: A Study of the Hopi Indians, pp. -1. Harper, New York, 1950. In 1960, the Indian Health Service estimated a total popultion of 4480 and an annual rate of increase between 3 and 4%. In 1970 the U.S. census of the total Hopi population was 7236. The annual rate of increase had dropped to about 1.75%. Kunitz S. J. Navajo and Hopi fertility. Hum. Biol. 46, 435-451, 1974. In 1975, the- Indian Health Service estimated the reservation oopulation at 6054. The Hooi Census Department estimate for the same year was-6446. Both believe that the reservation population constitutes about 80% of the total Hopi population. Using these figures we have made general estimates of the reservation population for the years covered by this study. The Indian Health Service hospitals in Keams Canyon, Tuba City, Winslow, and Pheonix, Arizona and in Gallup, New Mexico. USDHHS Public Health Service, Vital Statistics of the United States. Hyattsville, Md, 195&1980. Conrad R. D. and Kahn M. W. An epidemiological study of suicide and attempted suicide among the Papago Indians. Am. J. Psychiat. 131, 69-72, 1974. In this paper all rates are expressed as cases per 100,000 population. Shore J. H. American Indian suicide-fact and fancy. Psychiatry 38, 86-91, 1975. Brandt R. B. Hopi Ethics, p. 194. University of Chicago Press, Chicago, Ill., 1954. Henry A. F. and Short J. F. Jr. Suicide and Homicide: Some- Economic, Sociological, and Psychological Aspects of Aggression, p. 76. The Free Press, New York, 1954. USDHHS, Public Health Service, Vital Statistics of the United States. Hyattsville Md, 1950-1980. Chi square analysis of the hypothesis that the incidence of suicide among the younger age groups was higher between 1971 and 1985 yielded chi square values in the neighborhood of 0.1 (chi square corrected for continuity; degrees of freedom, 2; probability, 0.7) when the age groups were aggregated (15-29 and 15-25 years) and when the 15-19 year age group was considered alone. See Kunitz S. J. Disease Change and the Role of Medicine: The Navajo Experience, pp. 108-109. Univer- sity of California Press, Berkeley, Calif., 1983. Levy J. E. Navajo suicide. Hum. Org. I&308-318,1965; Van Winkle N. S. and May P. Native American suicide in New Mexico, 1957-1979. Hum. Org. 45, 296-309. Massey J. T. Suicide in the United States, 195&1964. Vital and Health Statistics, Series 20, Number 5. National Center for Health Statistics, Washington, D.C., 1967; Frederick C. J. Current trends in suicidal behavior in the United States. Am. J. Psychother. 32, 172-200, 1978. Levy J. E., Kunitz S. J. and Henderson E. B. Honi deviance in historical and epidemiological perspectiv;. In Essqvs in Honor of David F. Aberle (Edited bv Jorgensen J. and Donald L.). Folklore Institute Pr&, Berkeley, Calif. In press.

Since this study depended largely on hospital records which reflect utilization patterns and characteristics of the health care system as well as population characteristics, it was important to get some idea of the biases these data these may have introduced. To this end we


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collected information on Hopi patients treated in IHS

hospitals for gall bladder disease, a common chronic condition among American Indians. There were 130 Hopi patients with this diagnosis in the three years 1965-1967. Of these, 27 (20.8%) gave off reservation addresses, almost precisely what would have been expected on the basis of the IHS and tribal population estimates. The distribution of the 103 patients living in ‘progressive’ and ‘traditional’ villages on the reservation did not differ from the distribtuion of the population by village in the 1968 Bureau of Indian Affairs census. The gall bladder patients were used as normal controls from whom social and genealogical data were gatherted for comparison with the cases of social deviance. Some error is introduced by the fact that the age and sex structure of the cases of social deviance and the controls are not identical. Since, however, we have been concerned with their parents’ marriage patterns, we do not regard this as introducing significant error. Lowie R. H. Notes on Hopi clans. Am. Musm Nat. Hist. Anfhrop. Papers 30, 3055360, 1929. Stephen A. M. Hopi Journal, p. 1047. Columbia Univer- sity Press, New York, 1936. Dozier E. P. Hano: A Tewa Indian Community in Arizona, pp. 23-31. Holt, Rinehart, Winston, New York, 1966. Brandt R. B. Hopi Ethics, pp. 23-27. University of Chicago Press, Chicago, Ill., 1954. Eggan F. The American Indian: Perspectives for the Study of Social Change, p. 124f. Aldine Press, Chicago, Ill., 1966. Eggan F. The Social Organization of the Western Pueb- los, p. 103. University of Chicago Press, Chicago, Ill., 1950. Titiev M. Old Oraibi: a study of the Hopi Indians of Third Mesa. Peabody Musm Am. Archeol. Ethnol. Harvard Univ. Papers 22, 207-211, 1944.

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A suicide prevention program for Hopi youth

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